Subscribe to this blog

Get GeriPal Email Updates

Search This Blog

Antipsychotics for Sleep: When Did This Become a Thing?

Sleep. It’s sometimes hard enough to get enough at home with all the distractions of daily life. It’s only made more difficult in the hospital setting.

We’ve seen a lot of interventions to help with this that generally consist of pills, because as compared to changing the environment or culture of the hospital, as it’s an easy intervention. However, most of these have little to no evidence that they work.

The latest one that I just saw in the hospital was prescriptions for quetiapine, an antipsychotic, for sleep. I thought to myself, well that’s odd. Hopefully this won’t become a thing. I’m sad to say, just like Pokémon Go, it has.

One of the authors then looked at all of the medical records for quetiapine prescriptions, dosing, and indication. If they didn't have a comorbid psychiatric condition (eg, schizophrenia, major depressive, or bipolar affective disorder) or evidence of delirium it was assumed that they were receiving night time dosing of quetiapine for sleep.

What they found was shocking. One out of every ten patients (13.0%) received quetiapine during hospitalization, 64.0% of which received the medication at bedtime for sleep. That’s 8% of hospitalized patients getting quetiapine for sleep. Most of these individuals were newly initiated on this antipsychotic in the hospital. Sadly, 1 in 7 patients who first received quetiapine for sleep in the hospital was discharged home with at least a 1-month prescription.

Comments

It's ridiculous that these are being prescribed for sleep. They deplete critical nutrients too, yet no one ever discusses it: http://www.optimallivingdynamics.com/blog/7-important-nutrients-depleted-by-psychiatric-drugs-antidepressants-antipsychotics-stimulants-benzodiazepines-induced-guide-vitamins-medications

In post-acute, skilled nursing settings, we are required to consent patients/healthcare proxies whenever we prescribe psychoactive medications and specifically antipsychotics. We have also noticed a small rise in patients being discharged to us on antipsychotics for insomnia, often without their clear understanding or consent. For so many reasons, not a good practice. As attendings and geriatrics consultants we should be taking a stand and educating trainees about the dangers of this approach.

Popular posts from this blog

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life. Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation. It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

In this week's GeriPal podcast we discuss delirium, with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Dr. Inouye's research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 200 peer-reviewed original articles to date. She has developed and validated a widely used tool to identify delirium called the Confusion Assessment Method (CAM), and she founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients.

We are also joined by guest host Lindsey Haddock, MD, a geriatrics fellow at UCSF who asks a great question about how to implement a HELP program, or aspects of the program, in a hospital with limited resources.

Estimating prognosis is hard and clinicians get very little training on how to do it. Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5. The question is, aren't we better as palliative care clinicians than others in estimating prognosis? This is part of our training and we do it daily. We got to be better, right?

Big findings from this JPSM paper include that we, like all other clinicians, are an optimistic bunch and that it actually does impact outcomes. In particular, the people whose survival was overestimated by a palliative care c…

GeriPal (Geriatrics and Palliative care) is a forum for discourse, recent news and research, and freethinking commentary. Our objectives are: 1) to create an online community of interdisciplinary providers interested in geriatrics or palliative care; 2) to provide an open forum for the exchange of ideas and disruptive commentary that changes clinical practice and health care policy; and 3) to change the world.

No confidential patient information should be placed on GeriPal, nor should any confidential information be placed in the comments. The information provided on GeriPal is designed to complement, not replace, the relationship between a patient and and his/her own medical providers. The editors (Alex Smith and Eric Widera) reserve the right to remove comments that are deemed inappropriate due to the commercial, abusive, or offensive nature of a comment. If you think your comment was deleted for inappropriate reasons, please email either Alex or Eric.

GeriPal's mission is to improve the disemination of information in both geriatics and palliative medicine. GeriPal was created with the support of the Division of Geriatrics at the University of California San Francisco. Its content though is strictly the work of its authors and has no affiliation with or support from any organization or institution. All opinions expressed on this website are solely those of its authors & do not reflect the opinions of any academic institution or medical center. This web site does not accept advertisements. All email addresses collected by GeriPal for feed distribution will be kept confidential and will never be used for commercial reasons. If you reproduce the material on the website please cite appropriately. For questions regarding the site please email Alex Smith, MD (aksmith@ucsf.edu) or Eric Widera, MD (eric.widera@ucsf.edu)